Ingrown Toenails

An ingrown toenail (onychocryptosis) is a common, painful condition that occurs when a section of the nail grows into the skin and becomes embedded in the soft tissues. An ingrown toenail most commonly affects the big toe and can occur secondary to trauma, incorrect trimming of the nail, and/or tight shoes. Occasionally they may be hereditary. Toenails should be cut or trimmed straight across without rounding the corners. Tight shoes may lead to ingrown toenails due to pressure from the shoe on the sides of the nail encouraging it to curl into the soft tissues.

Symptoms

Symptoms of an ingrown toenail include swelling and redness of the skin around the nail as well as pain. The pain may be worse with shoe wear. There may be associated watery or purulent drainage.

Treatment

An ingrown toenail may be treated with conservative or surgical methods. Conservative treatment includes:

Soaking the affected toe(s) in warm water with Epsom salt for thirty minutes twice a day

Wearing open toe shoes or going barefoot

Proper nail trimming

Massaging the skin around the nail

A small piece of cotton may be placed under the corner of the toenail to lift it up from the skin.

If purulent drainage is present an antibiotic will be prescribed.

If conservative treatment has failed or the nail has become chronically ingrown then a procedure called partial toenail ablation may be performed.

Partial Toenail Ablation

This procedure is used to remove the ingrown portion of the nail. First the toe is numbed with a local anesthetic. Then the toenail is cut along the edge that is growing into the skin and this portion of the nail is removed. A liquid solution is then applied to the exposed nail bed. This usually keeps the toenail from growing into the skin again. The toe is then wrapped in a bulky dressing. The rate of recurrence or re-growth of the treated side varies from 10-30 % and is influenced by attention to the post procedure care of the nail and toe.

Care for the toenail after partial ablation

The dressing that is applied after the procedure should remain in place and dry for two days. After two days, the dressing may be removed and you should begin warm water and Epsom salt soaks twice a day for thirty minutes for two weeks. The wound should remain clean and dry and does not require a bandage after the first two days. Avoid sports/PE and wear open toe shoes for two weeks after the procedure. A follow-up appointment should be scheduled for 12 – 14 days following the procedure.

Surgical Ablation

This procedure is used to definitively remove and permanently narrow the affected side of the infected toe. This procedure is performed primarily under general anesthesia due to the utilization of a tourniquet to aid in performing the procedure. The excessive infected tissue is removed. A small portion of skin along the side of the infection is removed. An incision is made at the base of the toenail to find and remove the tissue that generates the growing toenail. When this tissue is removed that portion of the nail will not re-grow. This will permanently narrow the toenail. The goal of this procedure is to remove pressure along the side of the toenail where the infection has occurred and prevent the toenail from re-growing down this path.